The Resource Group (RG) Method
|The Resource group approach. The resource group method offers a new mechanism for the delivery of programmes for treatment and care of people with any complex and severe mental illness disorder. Multiprofessional community based mental health teams are the basic providers of person-centred care, treatment and support. For those patients with severe mental illness resource groups (clinical microsystems), as a rule including the patient, the psychiatrist, one or two case managers, as well as resource persons from families and significant others in the network of the patients are established. The patients have the final say on who is to be included in their resource groups.
All treatment and care interventions are carried out through the resource group teams. In the resource groups, the patient is involved in informed shared decision making by the rule “nothing about me, without me”. In the beginning the groups mostly are managed by the clinical care manager(s) and the patient together. The aim is to empower the patient to become the manager, supported by her/his care managers from the psychiatric and social services.
A Story of the Discovery of a New Mechanism for the Delivery of Personalized Psychiatry to People with Severe Mental Illness
The roots of the Resource Group (RG) method. During the 1980ies we fully moved most of the treatment and care for people with severe mental illnesses (SMI) from the Lillhagen mental hospital to out-patient clinics in the community. Assertive community treatment (ACT) was introduced to the mental health community by Stein and Test (1980), reporting a trial of a community programme to support seriously mentally ill individuals compared with standard hospital care. They demonstrated a truly remarkable reduction in hospitalization, and some social gains. Interestingly, their community programme was not called ACT but ’Training in Community Living (TCL)'(Burns 2010). As a part of an outpatient drug trial we replicated the TCL programme (Dencker, Lundin, Malm 1991). The TCL community-based psychosocial programme did not yield added benefits regarding symptom reduction or increased social adjustment. The continued search for the best community-based treatment programme was directed by the idealistic task force fronted by Philip May1. World-wide expertise and evidence were distilled as the Rational Rehabilitation (RR) outreach programme (Malm et al 2003). Our best practice, the RR programme was implemented by two community mental health teams specialized for psychoses and located in downtown Gothenburg. Three major components of the RR programme were drug therapy (May & Tuma 1965, Simpson 1994) family interventions (Goldstein & Miklowitz 1995, Leff et al 1989, Hogarty et al 1991) and social skills training (Liberman 2008).
Made by Sweden. By 1994 we began an RCT trial comparing two programmes for patients with schizophrenic disorders: the best practice community-based RR programme and “Integrated Care” (IC)(Falloon & Fadden 1993). A new element of the experimental arm, the IC programme, was to build a care unit in the community around family of the patient. A limitation for the fully implementation of the family intervention component of both the RR and IC programs was the fact that most Swedish patients with SMI did not live with their families of origin. In a joint process the Swedish teams2, within the context of the international outcome research project, developed the family interventions into a standing alone modality concept, a resource group team for each patient. The resource group composed of “who-matters-for-me” resource persons were selected from family, friends and significant others may be seen as extended family or as the patient´s own team/clan (Malm 2003). The resource group is where the concept of Shared Decision Making is practiced. The Swedish teams had discovered an innovative generic mechanism for a personalized delivery of mental health services to people with any complex and severe mental illness disorder: the resource group method.
During 1994-2012 a careful and deliberate process-based development took place aiming at the empowerment of the patient to become ’a heroic client’ (Duncan et al 2004). The processes involved research key players, at first hand the New Zealander psychiatrist Ian Falloon3, and patients, their families and significant others. Unlike most stakeholders in mental health, who have to rely on second-hand accounts or expert opinion, case managers and psychiatrists can weigh in directly with their advice, opinions and expertise, based on direct accounts from patients in case manager-patient (Falk & Allebeck 2002) as well as the doctor-patient relationships.
We discovered that SMI patients can participate in shared decision-making on their own treatment in their own resource group teams practicing the concepts “clinical microsystems” (Batalden et al 2007), “what-matters-to-me” (Leitsch 2016) and “who-matters-for-me”, namely, the Resource group method. Models, elements and mechanisms of delivery in clinical practice programmes for the treatment and care of patients with severe mental illness are accounted for in Table 1.
The idealistic Care and Treatment Committee (CTP)4 organized several case management conferences and took active part in international events to catch innovations on models and elements that could be added to improve the Swedish delivery approaches. Mainly founded in clinical expertise, secondary and qualitative research we found that the generic approach of the resource group method enhanced the values and outcomes of ’the assertive community treatment like’ (Killaspy 2009) local programme kits of the teams at Gothenburg and Lysekil (Malm et al 2003, Malm et al 2014. Malm et al 2015).
Table 1 Models, elements and mechanisms of delivery in clinical practice programme kits for the treatment and care of patients with severe mental illness.
|Clinical case management
Assertive community treatment (ACT)
|Case manager – patient relationship
Doctor – patient relationship
Shared decision making
Person-centred treatment and care
Empowerment of patients
Empowerment of psychiatrists
No discharge policy
|Drug therapy and careful monitoring of medicine
Social skills training
Non-drug somatic treatments
A digital device for triaging patients
Individual Placement and Support (IPS)
|Multiprofessional assertive community mental health teams. Team management (shared case load) according to the North-American ACT model
Multiprofessional assertive community mental health teams. Individual clinical case management and/or team management (shared case load) according to the Dutch Flexible ACT model (FACT)
Treatment and care interventions are carried out through resource group teams. As a rule, a resource group includes the patient, the psychiatrist and a case manager as well as resource persons from families and significant others in the network of the patients. Both individual clinical case management and team management approaches. Multiprofessional assertive community mental health teams according to the Dutch Flexible ACT model are the basic providers of care
The outcomes were social gains and increased satisfaction with services compared to a similar programme without resource groups. No patients were lost to services during the five-year RCT trial. These findings were supported by the international research project (Nordén et al 2012).
In conclusion, the Resource Group method may, 1/ be made an organisational component of any care and treatment programme kit, and 2/ yield better outcomes in the areas of social functioning, wellbeing and satisfaction with services as well as promote the values of patient empowerment and self-managing their illness (recovery).
References (a complete reference list by request)
Burns T. The rise and fall of assertive community treatment? International Review of Psychiatry. January 2010. DOI: 10.3109/09540261003661841
Leitsch J. https://www.youtube.com/watch?v=H_Z1ZvjlKDE
Surber R (editor). Clinical case management: A guide to comprehensive treatment of serious mental illness. Sage Publications, Inc. 1994.
Duncan BL. Miller SD, Sparks JA. The heroic client: A revolutionary way to improve effectiveness through client-directed outcome-informed therapy. Jossey-Bass, 200
“Model” refers to any existing framework or theory; this pertains to the “abstract” and intangible.
“Element” refers to any (abstract) concept or specific (practice) component to provide care and treatment, elements can be a part of a model or a programme.
“Programme” refers to any existing provision, practice or initiative, programmes are thus real-world approaches to provide care and treatment for patients or clients. These programmes can range from local to regional or national approaches.
“Method” refers to any defined treatment method or social intervention component.
“Integrated care” refers to structured efforts to provide co-ordinated, pro-active, person-centred, multidisciplinary care by two or more communicating and collaborating care providers. Providers may work at the same organisation or different organisations within the health care sector or across the health care, social care, or community care sectors (including informal care).